27 de Mar de 2023

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  1. Automatic Dysreflexia NUR 420 Palliative & Geriontology Nursing Daystar University
  2. DEFINITION • It is a condition that results from an exaggerated response of the autonomic nervous system to a noxious stimulus below the level of spinal injury. This response causes an uncontrolled and rapid increase in blood pressure, which can lead to serious complications such as stroke, seizures, and cardiac arrest if left untreated. 03/27/2023 Akal Lobenyo Morris 2
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  4. PATHOPHYSIOLOGY • The pathophysiology of autonomic dysreflexia involves an overreaction of the sympathetic nervous system, which causes vasoconstriction and a rapid increase in blood pressure. This increase in blood pressure stimulates the baroreceptors in the carotid sinus and aortic arch, but the reflex response is blocked by the spinal cord injury, leading to persistent hypertension. The symptoms of autonomic dysreflexia are caused by the activation of the sympathetic nervous system. 03/27/2023 Akal Lobenyo Morris 4
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  6. CAUSES • Bladder problems – full distended bladder urinary tract infection. Most common cause. • Bowel- hard stool in the rectum causes impaction. • Breakdown of skin-pressure ulcer, skin infection occurring below the site of injury. 03/27/2023 Akal Lobenyo Morris 6
  7. CLINICAL MANIFESTATION 1. Severe headache 2. Profuse sweating: The body may sweat excessively, even in cool or cold environments. 3. Flushing: The skin may become red and warm to the touch. 4. Piloerection: The hairs on the arms, legs, or back may stand on end. 03/27/2023 Akal Lobenyo Morris 7
  8. 5 Nasal congestion: The individual may experience stuffy or runny nose. 6 Nausea: The individual may feel sick to their stomach. 7 Bradycardia: The heart rate may slow down. 8 Rapid increase in blood pressure: This is the most significant and potentially life-threatening symptom of autonomic dysreflexia. Blood pressure can rise rapidly and cause serious complications, such as seizures, stroke, or even death. 03/27/2023 Akal Lobenyo Morris 8
  9. DIAGNOSTIC PROCEDURES • There’s no single test that can diagnose autonomic dysreflexia (AD), so healthcare providers and caregivers largely base the diagnosis on the:  Medical history, especially history of a spinal cord injury.  Current blood pressure compared to your baseline or “usual” blood pressure. Systolic blood pressure greater than 150 mmHg or more than 40 mmHg above baseline levels is usually considered indicative of autonomic dysreflexia.  Symptoms, especially severe headache. 03/27/2023 Akal Lobenyo Morris 9
  10. Cont…  Blood and urine tests.  Computed tomography (CT) and Magnetic Resonance Imaging (MRI)  Electrocardiogram and Spinal puncture 03/27/2023 Akal Lobenyo Morris 10
  11. Cont… • Tilt-table test- the patient lies on a table that can be tilted up to a standing position. Blood pressure, heart rate, and other vital signs are monitored while the table is tilted to different angles. If the patient experiences symptoms such as headache, sweating, nausea, or a sudden increase in blood pressure, it may indicate autonomic dysreflexia. • X ray • Drug testing 03/27/2023 Akal Lobenyo Morris 11
  12. MEDICAL MANAGEMENT - The most common agents used are nifedipine and nitrates. - Bite and swallow is the preferred method of administering nifedipine and not sublingual administration. - Other agents used are prazosin, captopril, terazosin, mecamylamine, diazoxide and phenoxybenzamine 03/27/2023 Akal Lobenyo Morris 12
  13. Cont… - Antihypertensives should be used with great caution with patients who have coronary artery disease. - If there’s poor response to treatment and the cause of automatic dysreflexia has not been identified the patient should be seen in an emergency department for monitoring and pharmacologic control of blood pressure. - There’s evidence that electrical stimulation of the spinal cord maybe a useful therapy though it’s not clear 03/27/2023 Akal Lobenyo Morris 13
  14. SURGICAL MANAGEMENT • Sympathectomy: This is a surgical procedure that involves cutting or blocking the sympathetic nerve fibres that control blood vessel constriction. This can help to reduce blood pressure and alleviate symptoms of AD. - Sacral nerve stimulation: This involves implanting a device that delivers electrical stimulation to the sacral nerves, which can help to control bladder and bowel function and reduce the frequency of AD episodes. - Intrathecal baclofen pump: This involves implanting a device that delivers a muscle relaxant medication called baclofen directly to the spinal cord, which can help to reduce muscle spasms and prevent AD. 03/27/2023 Akal Lobenyo Morris 14
  15. PALLIATIVE NURSING CARE • Assessment: The nurse should assess the individual for signs and symptoms of autonomic dysreflexia, such as severe headache, profuse sweating, flushing, piloerection, nasal congestion, nausea, bradycardia, and rapid increase in blood pressure. Blood pressure should be assessed every 2-5 minutes in emergency • -Identification and removal of triggers: The nurse should identify and remove any triggering stimuli, such as a full bladder, pressure ulcer, or ingrown toenail. If the triggering stimulus cannot be removed, the nurse should attempt to alleviate the symptoms. 03/27/2023 Akal Lobenyo Morris 15
  16. Cont… • -Positioning: The individual should be positioned in a sitting position at 90 degrees with the head elevated and the legs lowered to reduce the risk of complications. • Communication: The nurse should provide education to the individual and their family about autonomic dysreflexia and how to manage it. The nurse should also ensure that the individual has a plan in place for managing episodes of autonomic dysreflexia, including when to seek medical attention. 03/27/2023 Akal Lobenyo Morris 16
  17. Cont… Emotional support: The nurse should provide emotional support to the individual and their family, as autonomic dysreflexia can be a frightening and overwhelming experience. • Palliative nursing care of autonomic dysreflexia should be tailored to the individual's needs and preferences. The goal is to help the individual achieve the best possible quality of life despite their condition. • -Comfort measures: The nurse should provide comfort measures, such as ice packs or warm blankets, to help alleviate symptoms. 03/27/2023 Akal Lobenyo Morris 17
  18. REFERENCES • Allen, K. J., & Leslie, S. W. (2018). Autonomic dysreflexia. • Delhaas, E. M., Frankema, S. P., & Huygen, F. J. (2021). Intrathecal baclofen as emergency treatment alleviates severe intractable autonomic dysreflexia in cervical spinal cord injury. The Journal of Spinal Cord Medicine, 44(4), 617-620. • Linsenmeyer, T. A., Gibbs, K., & Solinsky, R. (2020). Autonomic dysreflexia after spinal cord injury: beyond the basics. Current Physical Medicine and Rehabilitation Reports, 8, 443-451. 03/27/2023 Akal Lobenyo Morris 18